Paulo Ricardo Saquete Martins-Filho

Do Metal Post–retained Restorations Result in More Root Fractures than Fiber Post–retained Restorations? A Systematic Review and Meta-analysis

INTRODUCTION Teeth requiring endodontic treatment commonly have compromised a coronal tooth structure that often requires the use of an intraradicular post to retain the coronal restoration. Although usually successful, catastrophic failures requiring extraction have been reported in the literature. The aim of this systematic review was to analyze clinical trials and cohort studies that evaluated the incidence rate of root fractures in post-retained restorations. The hypothesis was that the incidence rate related to the use of metal posts was higher than that of fiber posts. METHODS A MEDLINE search for clinical studies reporting the incidence of root fractures of restorations retained with fiber posts or metal posts of endodontically treated teeth with a more than 5-year follow-up was conducted from inception to January 2014. Seven randomized clinical trials and 7 cohort studies were included. RESULTS The pooled survival rate was 90% (95% confidence interval, 85.5-93.3) for metal-based posts and 83.9% (95% confidence interval, 67.6-92.8) for fiber-reinforced posts. The overall incidence rate of root fractures (catastrophic failures) was similar between metal and fiber posts. Prefabricated metal posts and carbon fiber posts had a 2-fold increase in the incidence rate of root fractures compared with cast metal posts and glass fiber posts, respectively. CONCLUSIONS The results of this study did not show significant differences for root fracture incidence between metal- and fiber posts. However, the studies included in this review presented a high risk of bias, and further well-designed clinical studies are required to confirm these findings.

The prevalence of actinic cheilitis in farmers in a semi-arid northeastern region of Brazil

Background  Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to solar radiation. Despite being a relatively common lesion in tropical countries, the data related to AC prevalence in Brazil are sparse, particularly in regions with high levels of ultraviolet radiation.

Role of inflammation in oral carcinogenesis (Part II): CD8, FOXP3, TNF-α, TGF-β and NF-κB expression

Due to the frequent presence of inflammation in cases of carcinoma and its use as a parameter for the assessment of tumor aggressiveness, the role of inflammation in oral carcinogenesis was investigated. This was performed by evaluating the expression of cellular markers, cytokines and nuclear transcription factors that identify the cells that participate in the antitumor defense in cases of oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). A semi-quantitative immunohistochemical analysis was performed for the transcription factors cluster of differentiation 8 (CD8), forkhead box P3 (FOXP3), transforming growth factor (TGF)-β, tumor necrosis factor (TNF)-α and nuclear factor κ-light chain enhancer of activated B-cells (NF-κB), in cases of OED and OSCC. CD8, TGF-β, TNF-α and NF-κB participated in the processes of tumor transformation and progression. The presence of inflammatory infiltrate in cases of OED favors the transformation and invasion process when stromal TNF-α and NF-kB are overexpressed, as NF-kB activated by TNF-α during inflammation predisposes the lesion to transformation, functioning as a link between inflammation and cancer. The control of these inflammatory mediators may prevent malignant transformation in the oral cavity.

Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients.

ObjectiveThe objective of this study was to determine the frequency of signs and symptoms of temporomandibular disorder (TMD) in fibromyalgic patients. MethodsSixty subjects of both sexes (mean age, 49.2 ± 13.8 years) with fibromyalgia (FM) diagnosis were included in this study. All patients were examined by a calibrated investigator to identify the presence of TMD using the Research Diagnostic Criteria for TMD. ResultsThe most common signs (A) and symptoms (B) reported by FM patients were (A) pain in the masticatory muscles (masseter, 80%; posterior digastric, 76.7%), pain in the temporomandibular joint (83.3%), and 33.3% and 28.3%, respectively, presented joint sounds when opening and closing the mouth; (B) headache (97%) and facial pain (81.7%). In regard to the classic triad for the diagnosis of the TMD, it was found that 35% of the FM patients presented, at the same time, pain, joint sounds, and alteration of the mandibular movements. It was verified that myofascial pain without limitation of mouth opening was the most prevalent diagnosis (47%) for the RDC subgroup I. For the subgroup II, the disk displacement with reduction was the most prevalent diagnosis (21.6%). For the subgroup III, 36.7% of the subjects presented osteoarthritis. ConclusionsThus, there is a high prevalence of signs and symptoms of TMD in FM patients, indicating the need for an integrated diagnosis and treatment of these patients, which suggest that the FM could be a medium- or long-term risk factor for the development of TMD.

Traumatic bone cyst of the mandible: a review of 26 cases

UNLABELLED The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. OBJECTIVE To describe the clinical, surgical and radiographic findings of traumatic bone cysts. MATERIAL AND METHOD A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered. RESULTS Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions. CONCLUSION A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.O cisto osseo traumatico e uma entidade patologica caracterizada pela presenca de uma cavidade ossea assintomatica desprovida de revestimento epitelial, sendo raramente encontrado nos maxilares. OBJETIVO: Descrever as caracteristicas clinico-cirurgicas e radiograficas dos cistos osseos traumaticos. MATERIAL E METODO: Estudo de carater retrospectivo dos pacientes diagnosticados com cisto osseo traumatico em um servico de patologia oral no periodo de 1992 a 2007. Informacoes referentes as caracteristicas clinicas, radiograficas e cirurgicas foram coletadas. RESULTADOS: Vinte e seis casos de cisto osseo traumatico foram diagnosticados no periodo de 15 anos, 17 pertencentes ao sexo masculino e 09 ao sexo feminino. A maioria dos pacientes afetados pertencia as duas primeiras decadas de vida, nao relatava sintomatologia dolorosa, bem como historia de trauma na regiao da lesao. O padrao multilocular foi observado em apenas sete casos, dando as lesoes uma aparencia radiografica tumoral. A presenca de ar no interior da cavidade patologica foi relatada em aproximadamente 70% dos casos, sendo rara a presenca de conteudo serossanguineo e seroso. CONCLUSAO: A maior prevalencia de casos em pacientes jovens, a infrequente historia de trauma e o pequeno numero de lesoes com conteudo serossanguineo refletem a necessidade de se discutir a real patogenese do cisto osseo traumatico.

Prevalence of and risk factors for actinic cheilitis in Brazilian fishermen and women.

This study was conducted to investigate the prevalence of and risk factors for actinic cheilitis (AC) in Brazilian fishermen and women.

Immediate post-craniotomy headache.

Introduction Headache is the most common adverse event immediately following craniotomy and is due to the surgical procedure and meningeal irritation. Objectives The aim of this study was to investigate the prevalence of headache during the first week after a craniotomy, as well as headache intensity, whether pain was registered in the patients medical records, the use of analgesics and predictors of headache. Methods Ninety-one patients who underwent craniotomy were evaluated from the first to the seventh post-operative day. The variables analysed were gender, age, medical history, indication for craniotomy, surgery, occurrence of headache, pain registration in the medical records, length of hospital stay and analgesics consumption. Results On the second post-operative day, 29.2% of patients had a headache and there was under-reporting of this pain in the patients’ records. The analgesics used were non-steroidal anti-inflammatory in 75% of cases. An age of <45 years (odds ratio = 3.0, p = 0.041) and surgery duration lasting >4 hours (odds ratio = 3.7, p = 0.019) were associated with the occurrence of immediate post-craniotomy headache. Conclusion Further training should be provided to professionals caring for patients undergoing craniotomy to better manage post-operative headache.

Effect of preventive use of nonsteroidal anti-inflammatory drugs on sensitivity after dental bleaching: A systematic review and meta-analysis

BACKGROUND Tooth sensitivity associated with bleaching remains a challenge for clinicians. Inflammatory mediators released by the penetration of bleaching agents into dental tissues can sensitize nociceptors, leading to tooth sensitivity. TYPE OF STUDIES REVIEWED In this systematic review, the authors included randomized clinical trials in which the investigators compared the preventive use of nonsteroidal anti-inflammatory drugs (NSAIDs) with a placebo for sensitivity after dental bleaching. The authors included only studies in which the investigators evaluated in-office tooth bleaching with high-concentration hydrogen peroxide and reported the risk or the level of tooth sensitivity after bleaching. RESULTS The authors included 3 studies and evaluated the levels of sensitivity reported at up to 1 hour after the procedure and from 1 to 24 hours after bleaching. The authors also calculated the pooled relative risk for the effect of preventive use of NSAIDs on sensitivity after dental bleaching. Preventive analgesia with NSAIDs did not have a significant effect on the risk of sensitivity after dental bleaching or on the levels of sensitivity reported by patients. PRACTICAL IMPLICATIONS There is insufficient evidence about the use of NSAIDs to prevent tooth sensitivity caused by in-office bleaching procedures.

Oral lesions in renal transplant.

Abstract To prevent rejection of kidney transplants, patients must be kept in immunosuppressive therapy for a long time, which includes the use of drugs such as cyclosporine, azathioprine, cyclophosphamide, and prednisone. The action of these drugs reduces the general immune response of transplant patients and thus increases their susceptibility to infections. Moreover, these drugs increase the potential of developing lesions. Therefore, oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. The aim of this study was to investigate oral lesions in a group of 21 kidney transplant patients under immunosuppressive therapy attended during a 1-year period in the Nephrology Department of the Federal University of Sergipe, Brazil. Data related to sex, age, etiology of renal disease, types of renal transplant, time elapsed after transplantation, immunosuppressive treatment, use of concomitant agents, and presence of oral lesions were obtained. All patients received a kidney transplant from a living donor, and the mean posttransplantation follow-up time was 31.6 months; 71.5% used triple immunosuppressive therapy with cyclosporine A, azathioprine, and prednisone. Ten patients were also treated with calcium-channel blockers. Of the 21 transplant patients, 17 (81%) presented oral lesions. Gingival overgrowth was the most common alteration, followed by candidiasis and superficial ulcers. One case of spindle cell carcinoma of the lower lip was observed. Oral cavity can harbor a variety of manifestations related to renal transplantation under immunosuppressive therapy.

Fracture of the Coronoid Process, Sphenoid Bone, Zygoma, and Zygomatic Arch After a Firearm Injury

A rare case of fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch caused by a firearm is described. A 25-year-old man was hit in the face with a bullet, resulting in restricted mouth opening, difficulty chewing, and pain when opening the mouth. The clinical examination revealed a perforating wound in the right parotid region. A computed tomographic scan revealed a comminuted fracture of the left coronoid process with the bullet stopping in the intact left coronoid process. Treatment was bilateral coronoidectomy associated with speech therapy and was successful. Details of the clinical signs, computed tomography, treatment, and follow-up are presented.